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中醫看結核性胸膜炎癥狀怎樣

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中醫看結(jie)核(he)性胸膜炎癥狀怎樣


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金櫻子

金櫻子

2023-07-31 16:00:03

如(ru)果出現了結(jie)核性胸膜炎(yan)的這種疾病,需要使用中藥(yao)對于結(jie)核性胸膜炎(yan)進行治(zhi)(zhi)療,可以選擇口服月(yue)華丸進行治(zhi)(zhi)療,但是療效一(yi)般的情況下并沒有(you)抗(kang)結(jie)核藥(yao)物更為明確(que)。

最新回答共有5條回答(da)

  • 武漢-嚴**
    回復
    2023-07-31 19:19:35

    胸膜炎最常見的癥狀為胸痛。胸痛常突然出現,程度差異較大,可為不明確的不適或嚴重的刺痛,可僅在患者深呼吸或咳嗽時出現,亦可持續存在并因深呼吸或咳嗽而加劇。胸痛為壁層胸膜的炎癥所致,通常出現于正對炎癥部位的胸壁。亦可表現為腹部、頸部或肩部的牽涉痛 。胸膜炎
    由(you)于深呼(hu)吸(xi)可致疼(teng)痛(tong),故常引起呼(hu)吸(xi)淺快,患側(ce)(ce)肌肉運動較對側(ce)(ce)為(wei)弱(ruo)。如果發生(sheng)大量積聚,可致兩層胸(xiong)(xiong)膜相互分離(li),則(ze)胸(xiong)(xiong)痛(tong)可消(xiao)失。大量胸(xiong)(xiong)腔積液可致呼(hu)吸(xi)時單(dan)側(ce)(ce)或雙(shuang)側(ce)(ce)肺(fei)擴張受限,發生(sheng)呼(hu)吸(xi)困難(nan)。 這個胸(xiong)(xiong)膜炎(yan)的(de)治(zhi)療(liao)是(shi)(shi)很主要的(de),只有能正確(que)的(de)辯證治(zhi)療(liao),對這下藥(yao),才能使患者早日康復的(de)。像椒目葶(ting)藶湯就是(shi)(shi)不錯的(de)辦法(fa)的(de)

  • 匿名用戶
    回復
    2023-07-31 19:19:35

    目錄1拼音2英文參考3概述4疾病名稱5英文名稱6分類7ICD號8流行病學9結核性胸膜炎的病因10發病機制11結核性胸膜炎的臨床表現12結核性胸膜炎的并發癥13實驗室檢查14輔助檢查 14.1胸膜活檢14.2X線檢查 14.2.1葉間積液14.2.2肺下積液14.2.3包裹性積液14.2.4縱隔積液 14.3超聲波檢查 15結核性胸膜炎的診斷16鑒別診斷 16.1細菌性肺炎16.2類肺炎性胸腔積液16.3惡性胸腔積液 17結核性胸膜炎的治療 17.1一般治療17.2胸腔穿刺抽液17.3抗結核藥物治療 18預后19結核性胸膜炎的預防 19.1控制傳染源,減少傳染機會19.2普及卡介苗接種19.3預防性化療 20相關藥品21相關檢查附:1結核性胸膜炎相關藥物 1拼音

    jié hé xìng xiōng mó yán

    2英文參考

    tuberculous pleurisy

    3概述

    當肺部炎癥累(lei)及(ji)胸(xiong)(xiong)膜(mo)時(shi)引起的(de)胸(xiong)(xiong)膜(mo)炎癥稱為胸(xiong)(xiong)膜(mo)炎。在某些情況(kuang)下(xia)胸(xiong)(xiong)膜(mo)炎是通(tong)過血(xue)行感染(ran)而致病的(de),也有部分(fen)是與機體的(de)變(bian)態反應有關。因機體反應性(xing)不同,臨床可出現(xian)干性(xing)和滲出性(xing)胸(xiong)(xiong)膜(mo)炎兩種(zhong)狀況(kuang)。

    胸(xiong)(xiong)(xiong)膜炎(yan)(yan)(yan)(yan)可由(you)(you)一般的(de)細(xi)菌感染(ran)(ran)(ran)或特(te)殊的(de)細(xi)菌感染(ran)(ran)(ran)引(yin)(yin)起,常常伴有胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液。由(you)(you)于肺(fei)炎(yan)(yan)(yan)(yan)、肺(fei)膿腫和支氣管(guan)擴張感染(ran)(ran)(ran)引(yin)(yin)起的(de)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液稱為類(lei)肺(fei)炎(yan)(yan)(yan)(yan)性(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液(parapneumoniceffusion);需行(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)內(nei)插管(guan)引(yin)(yin)流治療(liao)的(de)類(lei)肺(fei)炎(yan)(yan)(yan)(yan)性(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液稱為復雜性(xing)類(lei)肺(fei)炎(yan)(yan)(yan)(yan)性(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液 (plicated parapneumonic effusion)。胸(xiong)(xiong)(xiong)膜炎(yan)(yan)(yan)(yan)常為單側(ce),雙側(ce)者常提示為血行(xing)播(bo)散性(xing)結(jie)核所致。積(ji)(ji)(ji)液少(shao)量(liang)至中等量(liang),由(you)(you)于結(jie)核性(xing)胸(xiong)(xiong)(xiong)膜炎(yan)(yan)(yan)(yan)滲(shen)液中的(de)蛋白(bai)質較高(gao),易引(yin)(yin)起胸(xiong)(xiong)(xiong)膜粘連及肥厚。

    結(jie)核(he)性(xing)胸(xiong)(xiong)膜(mo)炎須(xu)與細(xi)菌性(xing)肺炎和胸(xiong)(xiong)膜(mo)炎,以及惡性(xing)胸(xiong)(xiong)腔積液進行鑒別(bie)。

    結核(he)性胸(xiong)(xiong)膜(mo)炎的(de)治(zhi)療(liao)(liao)(liao)包(bao)括一般治(zhi)療(liao)(liao)(liao)、抽取胸(xiong)(xiong)液和抗結核(he)治(zhi)療(liao)(liao)(liao)。其化(hua)療(liao)(liao)(liao)原則與化(hua)療(liao)(liao)(liao)方(fang)法和活(huo)動性結核(he)相同(tong)。對(dui)結核(he)性胸(xiong)(xiong)膜(mo)炎進(jin)行及時(shi)正確的(de)治(zhi)療(liao)(liao)(liao),預后多(duo)良好,如病程遷延常至胸(xiong)(xiong)膜(mo)粘連、包(bao)裹,造(zao)成營養不良等,影響預后。

    4疾病名稱

    結核性胸膜炎

    5英文名稱

    tuberculous pleurisy

    6分類

    呼(hu)吸科 > 胸膜疾病 > 胸膜炎

    7ICD號

    A15.9

    8流行病學

    結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎可發生(sheng)(sheng)于(yu)任何(he)年(nian)(nian)齡,于(yu)青壯(zhuang)年(nian)(nian)時期最多見。在美(mei)國,類肺(fei)炎性(xing)胸(xiong)(xiong)(xiong)腔積液(ye)為胸(xiong)(xiong)(xiong)膜(mo)(mo)炎的(de)主(zhu)要(yao)病因,結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎每(mei)年(nian)(nian)僅1000例(li)左右(you)。艾滋病患(huan)者也(ye)常發生(sheng)(sheng)結(jie)(jie)核(he)感染(ran),但發生(sheng)(sheng)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎并(bing)不多見,主(zhu)要(yao)是其免疫(yi)系統(tong)受(shou)損所(suo)致。在我國,結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎是最常見的(de)一種胸(xiong)(xiong)(xiong)膜(mo)(mo)炎,約占(zhan)滲出性(xing)胸(xiong)(xiong)(xiong)腔積液(ye)的(de)54.8%。大約每(mei)30例(li)肺(fei)結(jie)(jie)核(he)中有1例(li)是結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎,國內報道結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎占(zhan)肺(fei)結(jie)(jie)核(he)4.7%~17.6%。

    9結核性胸膜炎的病因

    原(yuan)發(fa)性結(jie)核病是結(jie)核桿(gan)菌(jun)(jun)(jun)首次侵入機(ji)體(ti)所引(yin)(yin)起(qi)的(de)(de)疾病。結(jie)核桿(gan)菌(jun)(jun)(jun)有(you)4型:人型、牛(niu)型、鳥型和鼠型。而(er)對人體(ti)有(you)致病力者為人型結(jie)核桿(gan)菌(jun)(jun)(jun)和牛(niu)型結(jie)核桿(gan)菌(jun)(jun)(jun)。我國小兒結(jie)核病大多數由人型結(jie)核菌(jun)(jun)(jun)所引(yin)(yin)起(qi)。結(jie)核桿(gan)菌(jun)(jun)(jun)的(de)(de)抵抗力較(jiao)(jiao)強,除(chu)有(you)耐酸、耐堿、耐酒精(jing)的(de)(de)特性外(wai),對于(yu)冷、熱、干燥、光(guang)線(xian)以及化學物質等(deng)都有(you)較(jiao)(jiao)強的(de)(de)耐受(shou)力。濕熱對結(jie)核菌(jun)(jun)(jun)的(de)(de)殺菌(jun)(jun)(jun)力較(jiao)(jiao)強,在(zai)65℃ 30min,70℃ 10min,80℃ 5min即可(ke)殺死。干熱殺菌(jun)(jun)(jun)力較(jiao)(jiao)差,干熱100℃需(xu)20min以上才能(neng)殺死,因此干熱殺菌(jun)(jun)(jun),溫度需(xu)高、時間需(xu)長。痰(tan)內(nei)的(de)(de)結(jie)核菌(jun)(jun)(jun)在(zai)直接太陽(yang)光(guang)下2h內(nei)被殺死,而(er)紫(zi)外(wai)線(xian)僅需(xu)10min。相反在(zai)陰暗處可(ke)存活數月之久。痰(tan)液(ye)內(nei)的(de)(de)結(jie)核菌(jun)(jun)(jun)如用5%的(de)(de)石炭酸(苯(ben)酚)或20%漂(piao)白(bai)粉液(ye)消(xiao)毒,則(ze)需(xu)24h方能(neng)生效(xiao)。

    10發病機制

    引起結核性胸(xiong)膜炎的途(tu)徑有:

    ①肺門淋巴結核的(de)細菌(jun)經(jing)淋巴管(guan)逆流(liu)至胸膜(mo);

    ②鄰近(jin)胸膜的(de)肺(fei)結核病(bing)灶破潰(kui),使結核桿菌或結核感染(ran)的(de)產物直接進入胸膜腔內;

    ③急性(xing)或(huo)亞(ya)急性(xing)血行播散性(xing)結核引(yin)致(zhi)胸膜(mo)炎;

    ④機體的變(bian)應(ying)性較高(gao),胸膜對(dui)結核毒素(su)出(chu)現高(gao)度反應(ying)引起滲出(chu);

    ⑤胸(xiong)椎結核(he)和(he)肋(lei)骨結核(he)向胸(xiong)膜腔(qiang)潰(kui)破。

    以往認為結(jie)(jie)(jie)核(he)性(xing)胸腔積液(ye)系胸膜對結(jie)(jie)(jie)核(he)毒(du)素過敏的觀點(dian)是片面的,因為針式胸膜活(huo)檢(jian)或胸腔鏡活(huo)檢(jian)已(yi)經證實80%結(jie)(jie)(jie)核(he)性(xing)胸膜炎(yan)壁層胸膜有典型的結(jie)(jie)(jie)核(he)病(bing)理(li)改變。因此,結(jie)(jie)(jie)核(he)桿(gan)菌直接感染胸膜是結(jie)(jie)(jie)核(he)性(xing)胸膜炎(yan)的主要(yao)發(fa)病(bing)機(ji)制。

    早期胸(xiong)(xiong)(xiong)膜充血(xue),白細胞浸潤(run),隨(sui)后為淋巴細胞浸潤(run)占優勢。胸(xiong)(xiong)(xiong)膜表面(mian)有纖維素性滲出,繼而出現漿液性滲出。由于大(da)量纖維蛋白沉著于胸(xiong)(xiong)(xiong)膜,可形成(cheng)包裹性胸(xiong)(xiong)(xiong)腔積液或廣泛胸(xiong)(xiong)(xiong)膜增(zeng)厚。胸(xiong)(xiong)(xiong)膜常(chang)有結核結節形成(cheng)。

    11結核性胸膜炎的臨床表現

    大多數(shu)結核性胸(xiong)(xiong)膜(mo)炎是急性起病(bing)。其癥(zheng)狀主要(yao)表(biao)(biao)現為結核的(de)全身中毒(du)癥(zheng)狀和(he)胸(xiong)(xiong)腔積(ji)液(ye)(ye)(ye)所致的(de)局部癥(zheng)狀。結核中毒(du)癥(zheng)狀主要(yao)表(biao)(biao)現為發(fa)熱(re)、畏寒、出汗、乏(fa)力、食欲不振、盜(dao)汗。局部癥(zheng)狀有(you)胸(xiong)(xiong)痛(tong)(tong)、干咳和(he)呼(hu)(hu)吸(xi)(xi)困難(nan)。胸(xiong)(xiong)痛(tong)(tong)多位于胸(xiong)(xiong)廓呼(hu)(hu)吸(xi)(xi)運動幅(fu)度(du)最大的(de)腋前線(xian)(xian)或腋后線(xian)(xian)下方,呈銳痛(tong)(tong),隨深呼(hu)(hu)吸(xi)(xi)或咳嗽而加重(zhong)。由(you)于胸(xiong)(xiong)腔內積(ji)液(ye)(ye)(ye)逐漸增多,幾天后胸(xiong)(xiong)痛(tong)(tong)逐漸減輕或消失。積(ji)液(ye)(ye)(ye)對(dui)胸(xiong)(xiong)膜(mo)的(de) *** 可引起反(fan)射性干咳, *** 轉動時更(geng)為明顯(xian)。積(ji)液(ye)(ye)(ye)量少時僅有(you)胸(xiong)(xiong)悶(men)、氣促,大量積(ji)液(ye)(ye)(ye)壓迫(po)肺(fei)、心(xin)和(he)縱隔,則可發(fa)生(sheng)呼(hu)(hu)吸(xi)(xi)困難(nan)。積(ji)液(ye)(ye)(ye)產生(sheng)和(he)聚(ju)集越(yue)快(kuai)、越(yue)多,呼(hu)(hu)吸(xi)(xi)困難(nan)越(yue)明顯(xian),甚至可有(you)端坐(zuo)呼(hu)(hu)吸(xi)(xi)和(he)發(fa)紺。

    體征(zheng)與積(ji)(ji)液(ye)量和積(ji)(ji)聚部位有(you)(you)關。積(ji)(ji)液(ye)量少(shao)者(zhe)或(huo)(huo)葉間(jian)胸(xiong)(xiong)膜積(ji)(ji)液(ye)的胸(xiong)(xiong)部體征(zheng)不明顯,或(huo)(huo)早(zao)期可(ke)聽(ting)到(dao)胸(xiong)(xiong)膜摩(mo)擦音(yin)(yin)(yin)。積(ji)(ji)液(ye)中等量以上者(zhe)患(huan)側(ce)(ce)(ce)胸(xiong)(xiong)廓(kuo)稍凸,肋(lei)間(jian)隙(xi)飽滿(man),呼(hu)吸運動受(shou)限。氣管(guan)、縱隔(ge)和心臟向健側(ce)(ce)(ce)移位。患(huan)側(ce)(ce)(ce)語音(yin)(yin)(yin)震(zhen)顫減弱(ruo)(ruo)(ruo)或(huo)(huo)消失,叩診濁(zhuo)音(yin)(yin)(yin)或(huo)(huo)實音(yin)(yin)(yin)。聽(ting)診呼(hu)吸音(yin)(yin)(yin)減弱(ruo)(ruo)(ruo)或(huo)(huo)消失,語音(yin)(yin)(yin)傳導減弱(ruo)(ruo)(ruo)。由于(yu)接近(jin)胸(xiong)(xiong)腔(qiang)積(ji)(ji)液(ye)上界的肺(fei)被壓縮,在(zai)該(gai)部聽(ting)診時可(ke)發現呼(hu)吸音(yin)(yin)(yin)不減弱(ruo)(ruo)(ruo)反而增(zeng)強(qiang)。如(ru)有(you)(you)胸(xiong)(xiong)膜粘連與胸(xiong)(xiong)膜增(zeng)厚時,可(ke)見患(huan)側(ce)(ce)(ce)胸(xiong)(xiong)廓(kuo)下陷,肋(lei)間(jian)隙(xi)變窄,呼(hu)吸運動受(shou)限,語音(yin)(yin)(yin)震(zhen)顫增(zeng)強(qiang),叩診濁(zhuo)音(yin)(yin)(yin),呼(hu)吸音(yin)(yin)(yin)減弱(ruo)(ruo)(ruo)。

    干性(xing)胸(xiong)膜炎患側呼吸運動受限(xian),局(ju)部有壓痛,可(ke)觸(chu)及(ji)胸(xiong)膜摩(mo)擦(ca)感,聽診有胸(xiong)膜摩(mo)擦(ca)音(yin)。

    滲出性(xing)胸(xiong)膜炎胸(xiong)腔積液(ye)(ye)(ye)較(jiao)多時(shi),患側胸(xiong)廓(kuo)飽滿,肋間隙增寬,呼(hu)吸動度、語顫(zhan)減弱,氣管(guan)和心臟向健(jian)側移位,液(ye)(ye)(ye)平面以下扣診(zhen)濁(zhuo)音(yin)(yin)(yin),呼(hu)吸音(yin)(yin)(yin)減弱或消(xiao)失,液(ye)(ye)(ye)平面上方(fang)可有(you)支氣管(guan)肺泡(pao)呼(hu)吸音(yin)(yin)(yin),偶有(you)小水泡(pao)音(yin)(yin)(yin)。右側胸(xiong)腔積液(ye)(ye)(ye)時(shi)肝濁(zhuo)音(yin)(yin)(yin)界消(xiao)失。如有(you)胸(xiong)膜粘連肥厚(hou)局部胸(xiong)廓(kuo)下陷,呼(hu)吸運動受(shou)限(xian)扣診(zhen)濁(zhuo)音(yin)(yin)(yin),呼(hu)吸音(yin)(yin)(yin)減弱。

    12結核性胸膜炎的并發癥

    結核性胸膜炎(yan)可形成葉間胸膜炎(yan)、縱隔胸膜炎(yan),包裹性積液和肺底(di)積液等。

    13實驗室檢查

    結核性(xing)胸膜炎初期,血中白細胞(bao)(bao)總數(shu)(shu)可增高或(huo)正常,中性(xing)粒細胞(bao)(bao)占優勢,爾后白細胞(bao)(bao)計(ji)數(shu)(shu)正常,并轉為淋巴細胞(bao)(bao)為主(zhu)。紅(hong)細胞(bao)(bao)沉降率增快。

    胸(xiong)(xiong)液(ye)外觀多(duo)呈(cheng)草黃色(se),透明或微濁,或呈(cheng)毛玻璃狀。少(shao)數(shu)胸(xiong)(xiong)液(ye)可(ke)呈(cheng)黃色(se)、深黃色(se)、漿液(ye)血(xue)性(xing)(xing)乃至(zhi)血(xue)性(xing)(xing)。比重(zhong)1.018以上,Rivalta試驗(yan)陽(yang)性(xing)(xing)。pH約7.00~7.30。有核(he)細(xi)(xi)胞(bao)數(shu)(0.1~2.0)×109/L,急(ji)性(xing)(xing)期以中性(xing)(xing)粒細(xi)(xi)胞(bao)占優勢,而(er)后以淋巴細(xi)(xi)胞(bao)占優勢。蛋白(bai)定(ding)量(liang)30g/L以上,如(ru)大于50g/L,更支持(chi)結(jie)核(he)性(xing)(xing)胸(xiong)(xiong)膜炎(yan)的(de)(de)診(zhen)斷。葡萄糖含(han)量(liang)<3.4mmol/L,乳(ru)酸(suan)脫氫(qing)酶(LDH)>200U/L,腺苷脫氨(an)酶(ADA)>45U/L,干擾素γ>3.7μ/ml。癌胚抗原(yuan) (CEA)<20μg/L,流式細(xi)(xi)胞(bao)術細(xi)(xi)胞(bao)呈(cheng)多(duo)倍體(ti)(ti)。目前有報道測定(ding)胸(xiong)(xiong)腔積(ji)液(ye)的(de)(de)結(jie)核(he)性(xing)(xing)抗原(yuan)和抗體(ti)(ti),雖然結(jie)核(he)性(xing)(xing)胸(xiong)(xiong)膜炎(yan)者其胸(xiong)(xiong)腔積(ji)液(ye)的(de)(de)濃度明顯(xian)高(gao)于非結(jie)核(he)性(xing)(xing)者,但特(te)異性(xing)(xing)不高(gao),限制其臨床(chuang)應用。胸(xiong)(xiong)腔積(ji)液(ye)的(de)(de)結(jie)核(he)桿菌陽(yang)性(xing)(xing)率低于25%,如(ru)采(cai)用胸(xiong)(xiong)腔積(ji)液(ye)離心沉淀(dian)后涂(tu)片、胸(xiong)(xiong)腔積(ji)液(ye)或胸(xiong)(xiong)膜組織培養、聚(ju)合(he)酶鏈反應(PCR)等,可(ke)以提(ti)高(gao)陽(yang)性(xing)(xing)率。胸(xiong)(xiong)腔積(ji)液(ye)間皮細(xi)(xi)胞(bao)計數(shu)<5%。

    14輔助檢查14.1胸膜活檢

    針刺胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian)是診(zhen)斷(duan)結(jie)(jie)核性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎的重要手段。活(huo)檢(jian)(jian)的胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)組(zu)織除了(le)可行病(bing)(bing)理檢(jian)(jian)查(cha)外(wai),還可行結(jie)(jie)核菌的培養(yang)。如壁層胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)肉(rou)(rou)芽(ya)(ya)腫(zhong)改變(bian)提示結(jie)(jie)核性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎的診(zhen)斷(duan),雖(sui)然其他的疾病(bing)(bing)如真菌性(xing)疾病(bing)(bing)、結(jie)(jie)節病(bing)(bing)、土(tu)拉菌病(bing)(bing)(tuaremia)和風濕性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎均可有肉(rou)(rou)芽(ya)(ya)腫(zhong)病(bing)(bing)變(bian),但95%以上的胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)肉(rou)(rou)芽(ya)(ya)腫(zhong)病(bing)(bing)變(bian)系結(jie)(jie)核性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎。如胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian)未能發現(xian)(xian)肉(rou)(rou)芽(ya)(ya)腫(zhong)病(bing)(bing)變(bian),活(huo)檢(jian)(jian)標本(ben)應該做抗酸(suan)染色,因為(wei)(wei)偶然在標本(ben)中可發現(xian)(xian)結(jie)(jie)核桿菌。第(di)1次(ci)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian)可發現(xian)(xian)60%的結(jie)(jie)核肉(rou)(rou)芽(ya)(ya)腫(zhong)改變(bian),活(huo)檢(jian)(jian)3次(ci)則為(wei)(wei)80%左右。如活(huo)檢(jian)(jian)標本(ben)培養(yang)加(jia)上顯微鏡檢(jian)(jian)查(cha),結(jie)(jie)核的診(zhen)斷(duan)陽性(xing)率為(wei)(wei)90%。也可用(yong)胸(xiong)(xiong)(xiong)腔(qiang)鏡行直視下胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian),陽性(xing)率更高。

    14.2X線檢查

    胸腔(qiang)(qiang)積(ji)液(ye)在300ml以下(xia)時(shi)(shi)(shi),后前(qian)位X線胸片(pian)可(ke)能無(wu)陽性發現。少量(liang)積(ji)液(ye)時(shi)(shi)(shi)肋膈角(jiao)變鈍,積(ji)液(ye)量(liang)多(duo)在500ml以上(shang),仰(yang)臥位透視(shi)觀察,由(you)于(yu)積(ji)聚于(yu)胸腔(qiang)(qiang)下(xia)部(bu)的(de)液(ye)體散開,復見銳利(li)的(de)肋膈角(jiao)。也(ye)可(ke)患側(ce)(ce)(ce)臥位攝(she)片(pian),可(ke)見肺外側(ce)(ce)(ce)密(mi)度增高的(de)條狀影。中等量(liang)積(ji)液(ye)表現為胸腔(qiang)(qiang)下(xia)部(bu)均(jun)勻(yun)的(de)密(mi)度增高陰影,膈影被(bei)遮蓋,積(ji)液(ye)呈(cheng)(cheng)上(shang)緣外側(ce)(ce)(ce)高,內側(ce)(ce)(ce)低(di)的(de)弧形(xing)陰影。大量(liang)胸腔(qiang)(qiang)積(ji)液(ye)時(shi)(shi)(shi),肺野大部(bu)呈(cheng)(cheng)均(jun)勻(yun)濃密(mi)陰影,膈影被(bei)遮蓋,縱隔向健側(ce)(ce)(ce)移(yi)位。

    干(gan)性(xing)胸(xiong)膜炎(yan)患側僅肋膈(ge)角(jiao)(jiao)變(bian)頓(dun),滲出性(xing)胸(xiong)膜炎(yan)中等量以上(shang)積液(ye)(ye)可見大(da)片均勻致密影,其上(shang)緣呈從外(wai)上(shang)向(xiang)內(nei)下的弧形,肋膈(ge)角(jiao)(jiao)消失,膈(ge)影及心影不清。大(da)量積液(ye)(ye)時(shi)縱膈(ge)向(xiang)健側移位,肋間隙變(bian)寬,膈(ge)肌下降。

    結核性胸腔積液有些可表現(xian)為特殊類型,常見(jian)的(de)有:

    14.2.1(1)葉間積液

    液體積聚(ju)于一個(ge)或多個(ge)葉間隙(xi)(xi)內。表現為(wei)邊緣銳利的梭形(xing)陰(yin)(yin)影或圓(yuan)形(xing)陰(yin)(yin)影,在(zai)側位胸片上顯示積液位置與葉間隙(xi)(xi)有關。

    14.2.2(2)肺下積液

    液體(ti)主(zhu)要積聚于(yu)肺(fei)(fei)底與膈(ge)肌之間(jian),常與肋胸膜腔積液同時存在(zai)。直(zhi)立位時,表(biao)現(xian)為患側膈(ge)影(ying)增高,膈(ge)頂點由正常的內1/3處移到(dao)外1/3處,中部較平(ping)坦。左側肺(fei)(fei)底積液表(biao)現(xian)為膈(ge)影(ying)與胃(wei)泡之間(jian)的距離增大,患側肋膈(ge)角變鈍。如懷疑(yi)肺(fei)(fei)下積液,囑患者患側臥位20min后作胸透或(huo)胸片檢(jian)查,此時液體(ti)散開,患側肺(fei)(fei)外緣呈帶(dai)狀陰(yin)影(ying),并(bing)顯出膈(ge)肌影(ying)。帶(dai)狀陰(yin)影(ying)越厚,積液越多。

    14.2.3(3)包裹性積液

    系胸膜粘連形成的(de)局限性胸腔積(ji)液。肋胸膜腔包裹性積(ji)液常發(fa)生于下(xia)部的(de)后(hou)外(wai)側壁(bi),少數可發(fa)生在(zai)前胸壁(bi)。X線征象直立位或適當傾(qing)斜位時可顯示(shi)底邊貼(tie)附(fu)于胸壁(bi),內(nei)緣向(xiang)肺(fei)野凸(tu)出的(de)邊界銳利、密度均(jun)勻的(de)梭形或橢圓形陰影,陰影邊緣與胸壁(bi)呈鈍角。

    14.2.4(4)縱隔積液

    系縱(zong)隔(ge)(ge)胸膜腔的(de)積液(ye)(ye)。前縱(zong)隔(ge)(ge)積液(ye)(ye)表現(xian)為沿(yan)心(xin)臟(zang)及大血管邊沿(yan)的(de)陰(yin)影(ying),右前上(shang)(shang)縱(zong)隔(ge)(ge)積液(ye)(ye)陰(yin)影(ying)頗似(si)胸腺陰(yin)影(ying)或右上(shang)(shang)肺不張陰(yin)影(ying)。取右側臥(wo)位,左前斜30°位置20~30min后,攝該(gai) *** 的(de)后前位胸片,顯示(shi)上(shang)(shang)縱(zong)隔(ge)(ge)陰(yin)影(ying)明(ming)顯增寬。前下縱(zong)隔(ge)(ge)積液(ye)(ye)須與心(xin)臟(zang)增大陰(yin)影(ying)或心(xin)包積液(ye)(ye)相鑒(jian)別。后縱(zong)隔(ge)(ge)積液(ye)(ye)表現(xian)為沿(yan)脊柱的(de)三(san)角形或帶狀陰(yin)影(ying)。

    14.3超聲波檢查

    超聲探測胸(xiong)腔(qiang)積液的(de)靈敏度(du)(du)高,定位(wei)準(zhun)確,并可(ke)估計胸(xiong)腔(qiang)積液的(de)深度(du)(du)和積液量(liang),提示(shi)胸(xiong)腔(qiang)穿刺部位(wei)。亦可(ke)以(yi)和胸(xiong)膜增厚進行鑒別。

    15結核性胸膜炎的診斷

    根據(ju)患(huan)者的(de)病史和臨(lin)床表現,結核性胸(xiong)(xiong)膜(mo)炎(yan)一般可(ke)確(que)診。臨(lin)床表現主要為中度發熱、初起胸(xiong)(xiong)痛(tong)以后減輕(qing)、呼吸困難。體(ti)格檢(jian)(jian)查、X線(xian)檢(jian)(jian)查及(ji)超聲波檢(jian)(jian)查可(ke)作出(chu)胸(xiong)(xiong)液的(de)診斷。診斷性胸(xiong)(xiong)腔(qiang)穿刺(ci)、胸(xiong)(xiong)液的(de)常規檢(jian)(jian)查、生化檢(jian)(jian)查和細(xi)菌培養等為診斷的(de)必(bi)要措(cuo)施(shi),這些措(cuo)施(shi)可(ke)對75%的(de)胸(xiong)(xiong)液病因(yin)作出(chu)診斷。

    16鑒別診斷

    干性胸(xiong)膜(mo)炎應(ying)與肋間神經痛、流行(xing)性肌痛相鑒別(bie)。滲(shen)出性胸(xiong)膜(mo)炎要(yao)與風濕性疾(ji)病(bing)和惡性腫瘤(liu)引(yin)起的胸(xiong)腔積液(ye)相鑒別(bie)。

    結核性(xing)(xing)胸(xiong)膜炎(yan)須與細菌性(xing)(xing)肺炎(yan)和胸(xiong)膜炎(yan),以及(ji)惡性(xing)(xing)胸(xiong)腔積(ji)液進行鑒(jian)別。

    16.1細菌性肺炎

    結(jie)核性胸(xiong)膜(mo)炎(yan)(yan)的急性期(qi)常(chang)有發熱、胸(xiong)痛、咳嗽、氣促,血白細胞(bao)增多(duo),胸(xiong)片X線(xian)表現高密度均勻陰(yin)影,易(yi)誤診為(wei)肺(fei)炎(yan)(yan)。但(dan)肺(fei)炎(yan)(yan)時(shi)咳嗽多(duo)有痰(tan),常(chang)呈鐵銹(xiu)色痰(tan)。肺(fei)部為(wei)實變(bian)體(ti)征,痰(tan)涂(tu)片或培養常(chang)可發現致病菌。結(jie)核性胸(xiong)膜(mo)炎(yan)(yan)則以干(gan)咳為(wei)主,胸(xiong)部為(wei)積(ji)液(ye)體(ti)征,PPD試(shi)驗(yan)可陽性。

    16.2類肺炎性胸腔積液

    類肺(fei)炎性胸腔積(ji)(ji)液發生于細(xi)菌性肺(fei)炎、肺(fei)膿腫和支氣管擴張伴有胸腔積(ji)(ji)液者,患(huan)者多(duo)有肺(fei)部病(bing)(bing)變的(de)病(bing)(bing)史,積(ji)(ji)液量不多(duo),見于病(bing)(bing)變的(de)同側。胸液白細(xi)胞數明顯增多(duo),以中性粒(li)細(xi)胞為主,胸液培養(yang)可(ke)有致病(bing)(bing)菌生長。

    16.3惡性胸腔積液

    肺(fei)部惡性(xing)(xing)(xing)腫(zhong)瘤(liu)、乳腺癌、淋巴瘤(liu)的胸膜直接侵犯或轉(zhuan)移、胸膜間(jian)皮瘤(liu)等均(jun)可產生胸腔積液,而以(yi)肺(fei)部腫(zhong)瘤(liu)伴發胸腔積液最為常見。結核性(xing)(xing)(xing)胸腔積液與(yu)(yu)腫(zhong)瘤(liu)性(xing)(xing)(xing)胸腔積液的鑒(jian)(jian)(jian)別要點見表1。結核性(xing)(xing)(xing)胸膜炎(yan)(yan)有時(shi)須(xu)與(yu)(yu)系統性(xing)(xing)(xing)紅斑狼瘡性(xing)(xing)(xing)胸膜炎(yan)(yan)、類風濕性(xing)(xing)(xing)胸膜炎(yan)(yan)等伴有胸腔積液者鑒(jian)(jian)(jian)別,這(zhe)些疾病(bing)均(jun)有各(ge)自(zi)的臨床特點,鑒(jian)(jian)(jian)別不難。

    17結核性胸膜炎的治療

    結核性胸(xiong)膜(mo)炎的治療(liao)包括一般治療(liao)、抽取胸(xiong)液和抗結核治療(liao)。其化療(liao)原則與化療(liao)方(fang)法(fa)和活動性結核相同。

    17.1一般治療

    體溫38℃以(yi)(yi)上可臥(wo)床休(xiu)息(xi)(xi),一般結(jie)核性(xing)胸膜炎患者可以(yi)(yi)適(shi)當起床活(huo)動。總的休(xiu)息(xi)(xi)時間(jian)大約(yue)以(yi)(yi)體溫恢復正常(chang),胸液消失后仍須持續2~3個(ge)月。

    17.2胸腔穿刺抽液

    由于結核性胸(xiong)(xiong)膜(mo)炎胸(xiong)(xiong)液(ye)(ye)(ye)蛋白(bai)含(han)量和纖維蛋白(bai)含(han)量高,容易引(yin)起胸(xiong)(xiong)膜(mo)粘連(lian),故原則上(shang)應盡快(kuai)抽盡胸(xiong)(xiong)腔(qiang)(qiang)內(nei)積液(ye)(ye)(ye),每(mei)周2~3次。首次抽液(ye)(ye)(ye)不要超過(guo)(guo)700ml,以后每(mei)次抽取量約1000ml,最多不要超過(guo)(guo)1500ml。如(ru)(ru)抽液(ye)(ye)(ye)過(guo)(guo)多、過(guo)(guo)快(kuai),可由于胸(xiong)(xiong)腔(qiang)(qiang)內(nei)壓(ya)力驟降發(fa)生復張(zhang)后肺水腫和循環衰(shuai)竭(jie)。若出(chu)現頭暈、出(chu)汗、面色(se)蒼白(bai)、脈搏細(xi)弱(ruo)、四(si)肢發(fa)冷(leng)、血壓(ya)下(xia)(xia)降等(deng)反(fan)應,立即停止(zhi)抽液(ye)(ye)(ye),皮下(xia)(xia)注射0.5%腎上(shang)腺素0.5ml,同時靜脈內(nei)注射地(di)塞米(mi)松5~10mg,保留靜脈輸(shu)液(ye)(ye)(ye)導管,直至癥狀消失。如(ru)(ru)發(fa)生肺復張(zhang)后肺水腫,應進行相應的(de)搶(qiang)救。

    胸腔抽(chou)液(ye)有以(yi)下(xia)作用:

    ①減(jian)輕中(zhong)毒(du)癥狀,加速退熱。

    ②解除(chu)肺臟(zang)和心臟(zang)血管(guan)受壓,改善呼(hu)吸及循環(huan)功能。

    ③防止纖維蛋白沉著所致(zhi)胸膜粘(zhan)連肥厚。目前也有學者主張早期大量(liang)抽液(ye)或胸腔插(cha)管引流可(ke)減少(shao)胸膜增厚和胸膜粘(zhan)連等并發癥。

    17.3抗結核藥物治療

    一般采用(yong)鏈霉(mei)(mei)素(SM)、異(yi)煙肼(jing)(INH)和利福平(RFP)或鏈霉(mei)(mei)素(SM)、異(yi)煙肼(jing)(INH)、乙胺(an)(an)丁醇(EMB)聯合治(zhi)療結核(he)性(xing)胸膜炎。鏈霉(mei)(mei)素(SM)0.75~1.0g/d,肌內(nei)注射(she),療程2~3個月(yue)。異(yi)煙肼(jing)(INH)0.3g/d,頓服(fu)(fu),利福平(RFP) 0.45~0.6g/d,頓服(fu)(fu),乙胺(an)(an)丁醇(EMB) 0.75g/d,頓服(fu)(fu),上述口服(fu)(fu)藥物(wu)(wu)均連續服(fu)(fu)用(yong)1.0~1.5年。治(zhi)療過程必須注意抗(kang)結核(he)藥物(wu)(wu)的(de)副(fu)作(zuo)用(yong),如(ru)聽(ting)力的(de)變化(hua)、視(shi)覺的(de)變化(hua)和肝功能等,發生時(shi)應根(gen)據(ju)情況(kuang)減量或停用(yong)。

    結(jie)核性胸(xiong)(xiong)膜炎不主張常規使用糖皮質激素,因為有(you)許多副作用。當(dang)大(da)量胸(xiong)(xiong)腔積液、吸收不滿意或結(jie)核中毒癥(zheng)狀(zhuang)(zhuang)嚴重時(shi)可用潑(po)尼松30mg/d,至胸(xiong)(xiong)液明(ming)顯(xian)減(jian)(jian)少(shao)或中毒癥(zheng)狀(zhuang)(zhuang)減(jian)(jian)輕時(shi)每周減(jian)(jian)少(shao)5~10mg,一般4~6周停(ting)藥。減(jian)(jian)藥太快或用藥時(shi)間(jian)太短(duan),容易產(chan)生胸(xiong)(xiong)液或毒性癥(zheng)狀(zhuang)(zhuang)的(de)反跳。

    胸腔內注射抗結核藥(yao)(yao)物或皮質(zhi)激素沒有肯定意義。抗結核藥(yao)(yao)物在胸液的濃度已經足夠,胸腔內注射藥(yao)(yao)物對胸液的吸收及預(yu)防胸膜增厚(hou)與不用藥(yao)(yao)物者(zhe)沒有顯著(zhu)差異。

    18預后

    對結核性(xing)胸膜炎(yan)進(jin)行(xing)及時正確的治(zhi)療,預(yu)后多良好(hao),如病程(cheng)遷延常至胸膜粘連、包裹,造成營養不良等,影(ying)響預(yu)后。

    19結核性胸膜炎的預防19.1控制傳染源,減少傳染機會

    結(jie)核(he)(he)菌(jun)涂片陽性病人是結(jie)核(he)(he)主要傳染(ran)源,早期(qi)發(fa)(fa)現(xian)和(he)合理治療涂片陽性結(jie)核(he)(he)病人,是預防結(jie)核(he)(he)病的根(gen)本措施(shi)。嬰幼兒患(huan)活動性結(jie)核(he)(he),其家庭成員(yuan)應作(zuo)詳細檢查(攝(she)胸(xiong)片、PPD等)。對小學和(he)托(tuo)幼機構工作(zuo)人員(yuan)應定期(qi)體(ti)檢,及時發(fa)(fa)現(xian)和(he)隔離傳染(ran)源,能有效地減少感染(ran)結(jie)核(he)(he)的機會。

    19.2普及卡介苗接種

    實(shi)踐證明,接種(zhong)卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)是預防小兒結核病的(de)有效措施。卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)為(wei)法(fa)國醫師(shi)Calmette和(he)Guerin在(zai)1921年所發明,故又稱B.C.G,我國規定在(zai)新(xin)生兒期接種(zhong)卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao),按(an)規定卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)接種(zhong)于左上臂三角肌上端,皮內注射,劑(ji)量為(wei)0.05mg/次。劃(hua)痕法(fa)現已很少采用(yong)。衛生部1997年通知(zhi)取消7歲和(he)12歲的(de)卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)復種(zhong)計(ji)劃(hua)。但必要時(shi),對該年齡(ling)結素試驗陰性兒童仍可給予復種(zhong)。新(xin)生兒期卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)可與乙肝(gan)疫苗(miao)(miao)(miao)(miao)分(fen)手臂同天(tian)注射。

    接(jie)種卡介苗(miao)禁忌(ji)證:陽性結素反應(ying);濕疹或皮(pi)膚病患者;急性傳染病恢復期(1個月);先天性胸(xiong)腺(xian)發育(yu)不全癥或嚴(yan)重(zhong)聯合免疫缺(que)陷病患者。

    19.3預防性化療

    主要用于下列對象(xiang):

    (1)3歲以下嬰幼兒未接(jie)種過卡介(jie)苗而結素(su)試驗陽(yang)性者。

    (2)與開放性肺結(jie)核(he)病人(ren)(多(duo)系家庭成(cheng)員)密切(qie)接觸者。

    (3)結素試(shi)驗新近(jin)由陰(yin)性(xing)轉為陽(yang)性(xing)者(zhe)。

    (4)結素試驗呈強陽性反應者。

    (5)結素(su)試驗陽性需(xu)較長期使(shi)用腎上(shang)腺(xian)皮(pi)質激(ji)素(su)或其他免疫抑制劑者。

    20相關藥品

    苯酚、葡萄糖(tang)、腺(xian)苷、干(gan)擾素、腎上(shang)腺(xian)素、地塞米松、鏈霉素、異煙肼、利(li)福平(ping)、乙胺(an)丁醇、潑尼松

    21相關檢查

    白(bai)細(xi)胞計數、紅細(xi)胞沉(chen)降率(lv)、干擾素

    結核性胸膜炎相關藥物 氫化可的松注射液

  • 寧吉兒
    回復
    2023-07-31 19:19:35

    1、結核性胸膜炎一般急性起病,癥狀輕重不一。有全身中毒癥狀發熱、盜汗、乏力、胃納差等全身不適,胸痛、干咳以及咳嗽、局部針刺樣胸痛等。

    2、結核性胸膜炎患者早期主要為輕中度發熱、刺激性咳嗽和胸痛。疼痛與呼吸有關,于深呼吸或咳嗽加重時,暫停呼吸可減輕,患者被迫淺呼吸以減輕疼痛。多發生于胸廓擴張度最大的部位,如腋側胸下部及季肋部。累及膈胸膜時,可放射至頸、肩或上腹部。疼痛的程度不一,其性質視患者的痛閾和個體差異而定。疼痛性質多為劇烈尖銳的針刺樣疼痛,于深呼吸時加重。淺吸氣、平臥或向患側臥位,胸廓的擴張度減低,胸痛可減輕。

    3、結核性胸膜炎患者隨著病情進一步發展,胸痛減輕,但胸悶、氣急進行性加重,嚴重者呈端坐呼吸。

    4、結核(he)性胸膜炎患者(zhe)胸腔積(ji)液(ye)(ye)增多時(shi)可有氣促、心悸,而局部(bu)胸痛可減(jian)(jian)輕或消失(shi)。少量(liang)積(ji)液(ye)(ye)時(shi)無明(ming)顯(xian)體征,中或大量(liang)積(ji)液(ye)(ye)時(shi),患側(ce)呼(hu)吸運(yun)動減(jian)(jian)弱、語顫消失(shi),叩診呈濁音(yin)或實(shi)音(yin),呼(hu)吸音(yin)減(jian)(jian)弱或消失(shi),氣管、縱膈(ge)均可移向(xiang)健(jian)側(ce)。

  • xuzhujun728
    回復
    2023-07-31 18:18:25

    胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)是(shi)各(ge)(ge)(ge)(ge)種原(yuan)因引起的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)壁層(ceng)和(he)(he)臟(zang)層(ceng)的(de)炎(yan)(yan)(yan)(yan)癥(zheng)(zheng)。大(da)多(duo)(duo)(duo)為(wei)(wei)(wei)(wei)繼發(fa)(fa)(fa)(fa)于(yu)(yu)肺(fei)(fei)(fei)(fei)部(bu)和(he)(he)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)部(bu)的(de)病(bing)(bing)(bing)(bing)(bing)變(bian)(bian),也可(ke)(ke)為(wei)(wei)(wei)(wei)全(quan)身(shen)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)疾(ji)病(bing)(bing)(bing)(bing)(bing)的(de)局部(bu)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。臨(lin)(lin)床(chuang)(chuang)上胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)有(you)(you)(you)多(duo)(duo)(duo)種類型,以(yi)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)最為(wei)(wei)(wei)(wei)常見(jian)(jian)。本病(bing)(bing)(bing)(bing)(bing)屬中(zhong)醫(yi)“咳(ke)嗽、懸飲(yin)、肋痛(tong)(tong)(tong)”范(fan)(fan)疇。 1)臨(lin)(lin)床(chuang)(chuang)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian) 1.病(bing)(bing)(bing)(bing)(bing)情輕者(zhe)無(wu)癥(zheng)(zheng)狀(zhuang)。 2.主(zhu)(zhu)要(yao)(yao)臨(lin)(lin)床(chuang)(chuang)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、咳(ke)嗽、胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、氣(qi)急,甚(shen)則呼(hu)(hu)吸(xi)(xi)困難(nan),感(gan)染(ran)(ran)(ran)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)或(huo)(huo)(huo)(huo)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)繼發(fa)(fa)(fa)(fa)感(gan)染(ran)(ran)(ran)時,町有(you)(you)(you)惡寒(han)、發(fa)(fa)(fa)(fa)熱(re)。 3.不(bu)同病(bing)(bing)(bing)(bing)(bing)因所(suo)致(zhi)(zhi)(zhi)(zhi)的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)可(ke)(ke)伴(ban)有(you)(you)(you)相(xiang)應(ying)(ying)(ying)疾(ji)病(bing)(bing)(bing)(bing)(bing)的(de)臨(lin)(lin)床(chuang)(chuang)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 2)診(zhen)斷檢(jian)查(cha)(cha) 1.一(yi)(yi)般(ban)分為(wei)(wei)(wei)(wei)以(yi)下十型: ① 纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):即(ji)“干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)”,胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)局部(bu)滲(shen)出(chu)少(shao)(shao)量(liang)(liang)纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)而無(wu)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)。多(duo)(duo)(duo)由(you)(you)肺(fei)(fei)(fei)(fei)部(bu)炎(yan)(yan)(yan)(yan)癥(zheng)(zheng)蔓延(yan)至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi),多(duo)(duo)(duo)數無(wu)癥(zheng)(zheng)狀(zhuang),少(shao)(shao)數病(bing)(bing)(bing)(bing)(bing)人有(you)(you)(you)局限性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)針(zhen)刺(ci)樣痛(tong)(tong)(tong)。 ② 漿液(ye)(ye)(ye)(ye)(ye)(ye)纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):即(ji)“滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)”,為(wei)(wei)(wei)(wei)漿液(ye)(ye)(ye)(ye)(ye)(ye)和(he)(he)纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)滲(shen)出(chu)積(ji)(ji)(ji)聚于(yu)(yu)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)內,常由(you)(you)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、化膿(nong)(nong)(nong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、腫(zhong)瘤性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)所(suo)致(zhi)(zhi)(zhi)(zhi)。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)氣(qi)急為(wei)(wei)(wei)(wei)主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 ③ 結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):由(you)(you)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)菌(jun)(jun)(jun)(jun)從原(yuan)發(fa)(fa)(fa)(fa)綜(zong)合征的(de)淋(lin)巴(ba)結(jie)(jie)(jie)(jie)經淋(lin)巴(ba)管到達胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo),或(huo)(huo)(huo)(huo)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)下的(de)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)病(bing)(bing)(bing)(bing)(bing)灶(zao)蔓延(yan)至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。臨(lin)(lin)床(chuang)(chuang)主(zhu)(zhu)要(yao)(yao)有(you)(you)(you)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)膿(nong)(nong)(nong)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)。常有(you)(you)(you)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong),氣(qi)急及(ji)(ji)(ji)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)中(zhong)毒癥(zheng)(zheng)狀(zhuang)。 ④ 腫(zhong)瘤性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan);由(you)(you)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)內或(huo)(huo)(huo)(huo)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)外(wai)癌腫(zhong),直(zhi)接侵犯(fan)或(huo)(huo)(huo)(huo)轉移至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、進(jin)行性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)呼(hu)(hu)吸(xi)(xi)困難(nan),并伴(ban)原(yuan)發(fa)(fa)(fa)(fa)病(bing)(bing)(bing)(bing)(bing)灶(zao)的(de)相(xiang)應(ying)(ying)(ying)癥(zheng)(zheng)狀(zhuang)。 ⑤ 化膿(nong)(nong)(nong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):多(duo)(duo)(duo)由(you)(you)肺(fei)(fei)(fei)(fei)、食道、腹部(bu)感(gan)染(ran)(ran)(ran)等蔓延(yan)至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)惡寒(han)、高(gao)熱(re)、胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、咳(ke)嗽和(he)(he)咯吐(tu)膿(nong)(nong)(nong)痰(tan)。 ⑥ 真菌(jun)(jun)(jun)(jun)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):多(duo)(duo)(duo)由(you)(you)放線菌(jun)(jun)(jun)(jun)、白(bai)(bai)(bai)色念(nian)球菌(jun)(jun)(jun)(jun)累及(ji)(ji)(ji)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。 ⑦ 結(jie)(jie)(jie)(jie)締組(zu)織病(bing)(bing)(bing)(bing)(bing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):常見(jian)(jian)于(yu)(yu)類風濕性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)關節炎(yan)(yan)(yan)(yan)及(ji)(ji)(ji)系統(tong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)紅(hong)(hong)斑狼瘡等疾(ji)病(bing)(bing)(bing)(bing)(bing)。以(yi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、氣(qi)急及(ji)(ji)(ji)原(yuan)發(fa)(fa)(fa)(fa)疾(ji)病(bing)(bing)(bing)(bing)(bing)癥(zheng)(zheng)狀(zhuang)為(wei)(wei)(wei)(wei)主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 ⑧ 膽固醇(chun)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan);為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)液(ye)(ye)(ye)(ye)(ye)(ye)中(zhong)含(han)(han)有(you)(you)(you)大(da)量(liang)(liang)的(de)游離膽固醇(chun)結(jie)(jie)(jie)(jie)晶(jing),可(ke)(ke)能(neng)與(yu)脂肪代謝(xie)障礙(ai)有(you)(you)(you)關,臨(lin)(lin)床(chuang)(chuang)癥(zheng)(zheng)狀(zhuang)輕微。 ⑨ 乳(ru)(ru)糜胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong):為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)液(ye)(ye)(ye)(ye)(ye)(ye)中(zhong)含(han)(han)淋(lin)巴(ba)乳(ru)(ru)糜,多(duo)(duo)(duo)因腫(zhong)瘤、淋(lin)巴(ba)結(jie)(jie)(jie)(jie)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)、絲蟲病(bing)(bing)(bing)(bing)(bing)肉芽腫(zhong)壓迫或(huo)(huo)(huo)(huo)損傷胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)導(dao)管和(he)(he)乳(ru)(ru)糜池所(suo)致(zhi)(zhi)(zhi)(zhi)。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、氣(qi)急為(wei)(wei)(wei)(wei)主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 ⑩ 血(xue)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong):是(shi)指明(ming)(ming)顯的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)內出(chu)血(xue)。是(shi)由(you)(you)于(yu)(yu)自發(fa)(fa)(fa)(fa)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)氣(qi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)、含(han)(han)血(xue)管的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)黏連(lian)(lian)撕裂、或(huo)(huo)(huo)(huo)出(chu)血(xue)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胰腺炎(yan)(yan)(yan)(yan)等病(bing)(bing)(bing)(bing)(bing)因所(suo)致(zhi)(zhi)(zhi)(zhi)。主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、甚(shen)至(zhi)(zhi)(zhi)休克(ke)(ke)(ke)等癥(zheng)(zheng)狀(zhuang)。 2.查(cha)(cha)體:干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):呼(hu)(hu)吸(xi)(xi)運(yun)動(dong)受限,局部(bu)壓痛(tong)(tong)(tong),呼(hu)(hu)吸(xi)(xi)音減(jian)弱(ruo),可(ke)(ke)聞及(ji)(ji)(ji)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)摩擦音。滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)量(liang)(liang)多(duo)(duo)(duo)時患側呼(hu)(hu)吸(xi)(xi)運(yun)動(dong)受限,甚(shen)則強迫體位(wei),呼(hu)(hu)吸(xi)(xi)急促,心率加快,胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)廓飽滿(man),氣(qi)管向健側移位(wei),叩診(zhen)呈實音,語顫(zhan)、呼(hu)(hu)吸(xi)(xi)減(jian)弱(ruo)或(huo)(huo)(huo)(huo)消(xiao)(xiao)失。 3.x線檢(jian)查(cha)(cha):于(yu)(yu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)病(bing)(bing)(bing)(bing)(bing)變(bian)(bian)局限者(zhe)可(ke)(ke)無(wu)明(ming)(ming)顯變(bian)(bian)化。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)較(jiao)少(shao)(shao)時,見(jian)(jian)肋隔角模(mo)糊變(bian)(bian)鈍(dun)。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)較(jiao)多(duo)(duo)(duo)時,可(ke)(ke)見(jian)(jian)肺(fei)(fei)(fei)(fei)下野密度增加,陰影上緣自腋下向內下方(fang)呈弧形分布。 4.超(chao)聲波檢(jian)查(cha)(cha):可(ke)(ke)發(fa)(fa)(fa)(fa)現(xian)(xian)(xian)透聲良好的(de)液(ye)(ye)(ye)(ye)(ye)(ye)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)暗區(qu),可(ke)(ke)提示穿刺(ci)的(de)范(fan)(fan)圍、部(bu)位(wei)、深度。 5.實驗(yan)室檢(jian)查(cha)(cha): ① 胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)常規(gui)(gui)、生化、培養可(ke)(ke)判斷積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)的(de)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)質,及(ji)(ji)(ji)發(fa)(fa)(fa)(fa)現(xian)(xian)(xian)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)菌(jun)(jun)(jun)(jun)或(huo)(huo)(huo)(huo)其他致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)(bing)菌(jun)(jun)(jun)(jun)。 ② 結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)菌(jun)(jun)(jun)(jun)素(su)試驗(yan)及(ji)(ji)(ji)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)桿(gan)菌(jun)(jun)(jun)(jun)抗體陽性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)有(you)(you)(you)助于(yu)(yu)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)的(de)診(zhen)斷。 ③ 血(xue)常規(gui)(gui)檢(jian)查(cha)(cha)白(bai)(bai)(bai)細(xi)胞計數可(ke)(ke)正(zheng)常或(huo)(huo)(huo)(huo)增高(gao),血(xue)沉(chen)常加快。 6.本病(bing)(bing)(bing)(bing)(bing)應(ying)(ying)(ying)注(zhu)(zhu)意與(yu)支(zhi)氣(qi)管肺(fei)(fei)(fei)(fei)癌胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)轉移及(ji)(ji)(ji)肝、腎、心臟(zang)疾(ji)病(bing)(bing)(bing)(bing)(bing)所(suo)致(zhi)(zhi)(zhi)(zhi)的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)相(xiang)鑒(jian)別。 3)一(yi)(yi)般(ban)治(zhi)(zhi)療(liao) 1.西醫(yi): ① 抗生素(su)治(zhi)(zhi)療(liao) A. 抗結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)藥物(wu)治(zhi)(zhi)療(liao):適用(yong)(yong)于(yu)(yu)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)或(huo)(huo)(huo)(huo)滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)的(de)治(zhi)(zhi)療(liao)。異煙肼每(mei)(mei)日(ri)(ri)300毫(hao)克(ke)(ke)(ke)、或(huo)(huo)(huo)(huo)利福平(ping)每(mei)(mei)日(ri)(ri)壩(ba)毫(hao)克(ke)(ke)(ke)、或(huo)(huo)(huo)(huo)乙胺丁(ding)醇(chun)每(mei)(mei)日(ri)(ri)0.75--1克(ke)(ke)(ke),一(yi)(yi)次(ci)頓服(fu),連(lian)(lian)續服(fu)藥3個(ge)月。鏈霉素(su)每(mei)(mei)日(ri)(ri)0.75--1克(ke)(ke)(ke),肌(ji)注(zhu)(zhu),1--2月,與(yu)口(kou)服(fu)藥交替使用(yong)(yong),總計療(liao)程(cheng)6--9月。 B. 非(fei)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan):應(ying)(ying)(ying)針(zhen)對(dui)原(yuan)發(fa)(fa)(fa)(fa)病(bing)(bing)(bing)(bing)(bing)(如感(gan)染(ran)(ran)(ran)、腫(zhong)瘤等)選擇(ze)相(xiang)應(ying)(ying)(ying)的(de)藥物(wu)治(zhi)(zhi)療(liao)。 C. 化膿(nong)(nong)(nong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)或(huo)(huo)(huo)(huo)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)膿(nong)(nong)(nong)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)伴(ban)感(gan)染(ran)(ran)(ran)者(zhe):青霉素(su)C每(mei)(mei)日(ri)(ri)160--320萬單位(wei),分4次(ci)肌(ji)注(zhu)(zhu),并可(ke)(ke)于(yu)(yu)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)內再加注(zhu)(zhu)807單位(wei)。 ② 緩解(jie)疼痛(tong)(tong)(tong):口(kou)服(fu)阿司匹(pi)林0.6克(ke)(ke)(ke)或(huo)(huo)(huo)(huo)消(xiao)(xiao)炎(yan)(yan)(yan)(yan)痛(tong)(tong)(tong)50毫(hao)克(ke)(ke)(ke),每(mei)(mei)日(ri)(ri)3次(ci),或(huo)(huo)(huo)(huo)可(ke)(ke)待因15--30毫(hao)克(ke)(ke)(ke),每(mei)(mei)日(ri)(ri)3次(ci)。 ③ 胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)穿刺(ci)抽液(ye)(ye)(ye)(ye)(ye)(ye):適用(yong)(yong)于(yu)(yu)滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)大(da)量(liang)(liang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye),有(you)(you)(you)明(ming)(ming)顯呼(hu)(hu)吸(xi)(xi)困難(nan),或(huo)(huo)(huo)(huo)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)久(jiu)治(zhi)(zhi)仍不(bu)吸(xi)(xi)收者(zhe)。每(mei)(mei)次(ci)抽液(ye)(ye)(ye)(ye)(ye)(ye)量(liang)(liang)不(bu)宜(yi)超(chao)過1000毫(hao)升,每(mei)(mei)周(zhou)2--3次(ci)。 ④ 激素(su)治(zhi)(zhi)療(liao):與(yu)抗結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)藥物(wu)聯(lian)用(yong)(yong),對(dui)消(xiao)(xiao)除全(quan)身(shen)毒性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)癥(zheng)(zheng)狀(zhuang),促進(jin)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)吸(xi)(xi)收,防止胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)增厚黏連(lian)(lian),有(you)(you)(you)積(ji)(ji)(ji)極的(de)治(zhi)(zhi)療(liao)作用(yong)(yong)。可(ke)(ke)用(yong)(yong)強的(de)松15--30毫(hao)克(ke)(ke)(ke),分3次(ci)口(kou)服(fu),待全(quan)身(shen)癥(zheng)(zheng)狀(zhuang)改(gai)善,積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)明(ming)(ming)顯吸(xi)(xi)收減(jian)少(shao)(shao)時,可(ke)(ke)逐(zhu)漸減(jian)量(liang)(liang),一(yi)(yi)般(ban)用(yong)(yong)藥4--6周(zhou)。 2.中(zhong)醫(yi): ① 邪犯(fan)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)肺(fei)(fei)(fei)(fei):惡寒(han)發(fa)(fa)(fa)(fa)熱(re),咳(ke)嗽痰(tan)少(shao)(shao),胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)脅刺(ci)痛(tong)(tong)(tong),口(kou)苦咽干(gan)(gan)(gan),舌紅(hong)(hong)苔薄,脈(mo)弦(xian)數。 取(qu)瓜(gua)(gua)蔞、貓瓜(gua)(gua)草各(ge)(ge)(ge)(ge)30克(ke)(ke)(ke),柴胡(hu)、赤(chi)白(bai)(bai)(bai)芍各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke),黃芩(qin)、半夏、枳殼(ke)、桔梗、桑(sang)白(bai)(bai)(bai)皮各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke),甘草6克(ke)(ke)(ke)。 本方(fang)和(he)(he)解(jie)清(qing)熱(re),理氣(qi)通(tong)絡(luo)。 ② 飲(yin)停胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)脅:咳(ke)唾引痛(tong)(tong)(tong),呼(hu)(hu)吸(xi)(xi)困難(nan),咳(ke)逆喘息不(bu)能(neng)乎臥,舌苔白(bai)(bai)(bai)膩,脈(mo)沉(chen)弦(xian)。 用(yong)(yong)百部(bu)30克(ke)(ke)(ke),瓜(gua)(gua)萎、茯苓(ling)各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke),葶藶子11克(ke)(ke)(ke),桑(sang)白(bai)(bai)(bai)皮、蘇于(yu)(yu)、陳(chen)皮、半夏、椒目、薤白(bai)(bai)(bai)、橘紅(hong)(hong)各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke),甘草6克(ke)(ke)(ke)。 本方(fang)逐(zhu)水祛飲(yin)。 ③ 痰(tan)淤互(hu)結(jie)(jie)(jie)(jie):胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶,呼(hu)(hu)吸(xi)(xi)不(bu)暢,遷延(yan)經久(jiu)不(bu)已,舌紫暗、苔白(bai)(bai)(bai),脈(mo)弦(xian)。 取(qu)意苡仁(ren)30克(ke)(ke)(ke),瓜(gua)(gua)蔞、赤(chi)芍、茯苓(ling)各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke),旋復花、蘇于(yu)(yu)、杏仁(ren)、半夏、香附、陳(chen)皮、枳殼(ke)、路路通(tong)各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke),制乳(ru)(ru)沒(mei)各(ge)(ge)(ge)(ge)6克(ke)(ke)(ke)(包(bao)煎)。 本方(fang)化痰(tan)活血(xue),理氣(qi)和(he)(he)絡(luo)。 ④ 陰虛內熱(re):嗆咳(ke)少(shao)(shao)痰(tan),口(kou)干(gan)(gan)(gan)咽燥,潮熱(re)盜汗,五心煩熱(re),顴紅(hong)(hong),形體消(xiao)(xiao)瘦,舌紅(hong)(hong)少(shao)(shao)苔,脈(mo)細(xi)數。 用(yong)(yong)沙參(can)、麥(mai)冬、玉竹、花粉(fen)、百部(bu)各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke),太(tai)子參(can)13克(ke)(ke)(ke),桑(sang)白(bai)(bai)(bai)皮、地(di)(di)骨(gu)皮、功勞葉(xie)、銀柴胡(hu)、廣(guang)郁金、杏仁(ren)各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke),川貝粉(fen)6克(ke)(ke)(ke)(沖(chong)服(fu))。 本方(fang)滋陰清(qing)熱(re)。 4)預防調(diao)養 l. 注(zhu)(zhu)意休息,高(gao)蛋白(bai)(bai)(bai)及(ji)(ji)(ji)高(gao)維(wei)生素(su)飲(yin)食。 2. 治(zhi)(zhi)療(liao)應(ying)(ying)(ying)堅持、徹(che)底(di)。 愛心提示:以(yi)上介紹用(yong)(yong)方(fang),請務必(bi)咨(zi)詢當地(di)(di)正(zheng)規(gui)(gui)中(zhong)醫(yi)醫(yi)院,結(jie)(jie)(jie)(jie)合自身(shen)生理特點和(he)(he)不(bu)同的(de)病(bing)(bing)(bing)(bing)(bing)理變(bian)(bian)化,辨(bian)證選擇(ze)使用(yong)(yong)。 以(yi)上回答如果滿(man)意,請不(bu)要(yao)(yao)辜負(fu)我的(de)一(yi)(yi)片好意,及(ji)(ji)(ji)時采納為(wei)(wei)(wei)(wei)答案。

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